Richard Mabry: Lethal Remedy

"Her family is threatening to file a malpractice suit against the medical center and every doctor who had anything to do with her treatment."

In the midnight darkness, the lamp spilled a pool of yellow light onto the papers strewn helter-skelter over the scarred surface of his desk. The page shook in his hand as he stared at the figures scrawled in the margins. It all came down to this. The man scrabbled through the mass of documents and pulled another sheet. What was the line from Macbeth? "If it were done when 'tis done, then 'twere well it were done quickly." Decision time. He eased himself from the chair like the unfolding of a carpenter's rule. Do this, and he could say good-bye to this tiny office. He envisioned a corner suite with a view-maybe even a private washroom. But tonight the community restroom down the hall would do. The man locked himself in a stall and dug in his pocket for the dog-eared match folder he'd carried all day. He struck one match.

It fizzled impotently. Two more attempts before one lit. He bent it against its fellows and the whole folder ignited. He touched the improvised torch to the papers he held and watched as they burst into flame. Would the smoke set offthe fire alarm, activate the sprinklers?

He cursed under his breath for not thinking of that. He held the flaming mass lower in the toilet and fanned the air furiously with his free hand. The ashes dropped into the water, and he breathed again. He flushed twice, and it was over. He washed his hands, splashed water on his face, and walked back to his office. For good or for evil-probably a bit of both-it was done.

Jack Ingersoll reached out to punch the intercom button on his phone and was gratified to see that his hands were almost steady. A lesser man would have a tremor this morning. I should have been a surgeon. "Martha, page Dr. Pearson and tell him I'll be ready to make rounds in fifteen minutes. We'll start in the ICU." "Yes, sir," Martha called through the open door that connected her office with his.

Ingersoll ground his teeth. Would that woman never learn to use the intercom? Oh, well. It wasn't worth the hassle of trying to get her replaced. No, he'd just wait a bit. If things went as he expected, it wouldn't be long before he'd have a nice new office, along with an administrative assistant that he didn't have to share with two other doctors, someone who would cater to his wishes. And that day couldn't come soon enough for him. He swiveled in his chair and turned away from the windows and the bright sun that streamed in through them. The two Advil he'd washed down with black coffee seemed to be helping his headache. Another five minutes with his eyes closed, and he'd begin rounds. He hoped Pearson hadn't fouled up anything in his absence. At this point, every Jandramycin patient was pure gold. And he couldn't afford any slipups. "Jack, got a minute?" He opened his eyes and saw Sara in the doorway, one hesitant foot over the threshold. He couldn't recall that she'd come to his office since they'd divorced. Quick encounters on the ward or in the cafeteria, an occasional phone conversation about a patient, but never a personal visit. What was up?

"Sure. Come in. Sit down." She took one of the two visitors' chairs.

"I won't keep you. I know you're about to start rounds, but I wanted to let you know what happened while you were gone." He listened intently as she told him about the girl-what was her name? Chelsea.

That was it. She told him about Chelsea's sepsis. What were the odds?

Sepsis from Staph luciferus, responding to Jandramycin, only to be replaced by a garden-variety but potentially lethal infection from an indwelling urinary catheter. As Sara related the details, his mind raced to parse the implications. Apparently, Jandramycin wasn't effective against E. coli. No harm there. It had a specific niche, and if the drug was never used against any bacteria except Staph luciferus, it would still have a secure position in the pharmacotherapy of infections. The girl was still receiving Jandramycin along with the other drugs for her E. coli infection, and all the medications seemed to be working. That meant there was no incompatibility among them. Good to know and not the kind of information that would come up in a normal study protocol. Would the data from this case have to be excluded because of the confounding factors of the second infection and additional antibiotics? Ingersoll thought back to his conversation with Wolfe. We may have to be creative in the way we handle our data. So be it, then. He might have to be creative in the way he entered this information into the database, conveniently ignoring the additional drugs, but he couldn't afford to lose even a single patient from the study. He'd handle it.

Sara seemed to be running down, so he brought his full attention back to her. "So little… little Chelsea is getting better. Is that right?" "Yes. Her temp's down. White count returning to normal. No protein or cells in her urine this morning. I think she's turned the corner." "Well, that's the important thing," Ingersoll said. "I'll look in on her this morning, but you and Pearson should be able to handle things from here on out. You can call me if there are any questions." Sara frowned. "Jack, we were really afraid you'd erupt when you heard we had to go outside the study protocol to treat her.

I'm glad you're taking it this well." Ingersoll summoned up his most sincere look. "The patient is better. That's what's important." He rose and walked around the desk. He took his ex-wife's hand in both of his. "Sara, I appreciate your coming by to tell me in person. And I hope you won't be a stranger. I think we had something really good at one time, and I'm sorry I let it slip away while I was depressed about the death of our son. Maybe we can get it back."

Sara snuggled beneath the covers. Life was good.She and Jack had a lot of good years ahead of them, and the prospect made her smile. Maybe she'd give up her practice at the medical school to be a real stay-at-home mom. That was something a lot of her female colleagues talked about, and although none of them had actually made that move, it was obvious to Sara that deep down, most of them would like nothing better. She rolled over and reached across the bed, but a cry stopped her arm in mid-reach. Her mother's instinct drove her out of bed, and in a few seconds she was shrugging into her robe as her feet darted here and there in search of her slippers. Don't turn on the light. Don't want to wake Jack. The cries were louder now, and Sara quickened her steps. She paused at the doorway of the nursery, and the cries stopped as suddenly as they began. She shuffled across the carpet and peered over the edge of the crib. The bundle it held was jammed up against the far corner. She lifted the corner of the blanket and reached forth a hesitant hand to touch the angelic face.

It was cold and unmoving as marble. Her cry began as a low moan deep in her throat and escalated into a siren-like shriek. Sara sat up in bed and reached for the light at her bedside. Another nightmare. No, not another one. The same one. The same dream that had tormented her since the original scene played out. There was no hope of sleep now.

She shoved aside the bedclothes, grabbed her robe, and padded on slipper-shod feet into the kitchen. Maybe a snack would help. She passed the bathroom and remembered the bottle in the medicine chest.

One at bedtime as needed for sleep. Her doctor prescribed them after the baby died, but Sara refused to take them. No, she wanted to feel the full force of her grief. Jack, on the other hand, took them regularly. She'd watched him lie there in drug-induced sleep and hated him for it. How could he ignore the loss… their loss? The prescription was old now. Would the pills still be good? Why had she kept the half-full bottle anyway? She had no intention of drugging herself to sleep. Of course, there were times when she'd wanted to take all of them and fall into that deepest and most permanent of sleeps. But not tonight. She wasn't that desperate. Not yet. Sara shivered, even though the house was warm, and hurried into the kitchen. She spread a stack of crackers with peanut butter, poured a glass of milk, and eased into her accustomed chair in front of the TV.